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Pediatrics > Spina Bifida > Flashcards

Spina Bifida Flashcards

1
Q

Myelopdysplasia type: Open leison; Spinal nerve paralysis – spinal nerves protruding and sac is not intact; Assumed they do not have bowel and bladder control = spastic bladder –> hydronephrosis

A

Spina bifida aperta

- Myelomenigocele

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2
Q

Myelopdysplasia type: Hidden leison (non fusion of halves of the vertebral arches); No disturbance of underlying neural tissue

A

spina bifida occulta

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3
Q

Myelopdysplasia type: Proturding sac containing meninges and CSF (nerve roots and cord are intact); Lipomeningocele - Issues of tethered cord in the future (no problems initially)

A

Myelocele

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4
Q

How can you screen for spina bifida?

A
  1. AFP screen - After 14th week AFP continues to leak into amniotic fluid (positive); AFP peaks at 14 weeks
  2. Ultrasound - Lemon sign (flat frontal bone from pressure gradient causing brain to descend into spinal canal) prior to 24 weeks gestation
  3. Aminotic fluid analysis - Chronic villi sampling; Amniocentesis
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5
Q

What are primary impairments of spina bifida?

A
  1. Hydrocephalus - Arnold-Chiari Type II: Hypoplasia of cerebellum and herniation through foramen magnum; Deformity of medulla and cervical spinal cord; Caudal displacement of the brainstem; CSF released from the 4th ventricle is disrupted
  2. Motor paralysis
  3. Sensory deficits - WB in insensate joints; Skin breakdown
  4. Cognitive and Language Dysfunction - “cocktail personality”
  5. Latex allergy
  6. Upper limb dyscoordination
  7. Visuoperceptual deficits
  8. Cranial nerve palsies
  9. Spasticity and or progressive neuro dysfunction - Tethered cord
  10. Seizures
  11. Neurogenic bowel and bladder - All cases!
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6
Q

What are the S and S of shunt problems?

A
  1. Change in personality
  2. Sleepiness
  3. Lethargy
  4. Vomiting
  5. Headache and irritability
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7
Q

What are secondary impairments of spina bifida related to the MS system?

A
  1. Club feet
  2. Flexion contractures
  3. Dislocated hips
  4. Scoliosis
  5. Excessive lordosis
  6. Rotational deformities of the femur and tibia
  7. Flexed posture
  8. Foot deformities (typically pronation)
    - 50% of kids with SB are overweight after 6
    - osteoporosis
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8
Q

What are PT goals for SB?

A
  1. Promote functional skills
  2. Reduce contractures
  3. Reduce fractures
  4. Reduce obesity - Positioning, Age appropriate play, Adaptive devices
  5. Monitor for CNS deterioration, tethered cord, hydromyelia
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9
Q

What is PT management of SB?

A
  1. ROM exercises: parent education, initially in prone and sidelying
  2. Positioning
  3. motor development
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10
Q

Pt displays weakness of intrinsic foot m’s; good to normal foot PF (grade 4-5)
Orthotic program? expected ambulation?

A
  • FO

- community ambulation; ability to keep up with peers when walking outdoors

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11
Q

Pt displays fair or less foot PF (grade 3 or less); fair or better knee flexion (grade 3 or more); poor to fair or better hip extension and/or hip abduction (grade 2-3 or more)
Orthotic program? expected ambulation?

A
  • When the child initiates moving in prone position: standing with AFO
  • when child initiates steps: walking with SMO or AFO
  • in children with tibial torsion or knee rotation risk: walking with KAFO
  • community ambulation; walks in the community, w.c use only for long distances outdoors
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12
Q

Pt displays good to normal hip flexion and knee ext (grade +- 5); fair or less knee flexion (grade 3 or less); trace of hip ext, abd, and below-knee m’s
Orthotic program? expected ambulation?

A
  • when child raises to sitting: standing with HKAFO
  • when the child initiates steps: walking with HKAFO
  • in children with stable hip joints: walking with KAFO
  • in children with unstable hip: walking with reciprocating gait orthosis (RGO)
  • household ambulation; walks indoors; w/c only outdoors and for long distances indoors
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13
Q

Pt displays no knee ext activity; poor or less hip flexion (grade 2 or less); fair or good pelvic elevation
Orthotic program? expected ambulation?

A
  • when child raises to sitting: standing with HKAFO
  • when the child initiates steps: walking with RGO
  • Household ambulation; w.c use booth indoors and outdoors
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14
Q

Pt displays no m activity in lower limbs; no pelvic elevation
Orthotic program? expected ambulation?

A
  • when the child initiates reaching with the hand in prone position toward the vertical position: standing with standing orthosis
  • when the child initiates ambulation: swivel walker
  • nonfunctional ambulation or standing function
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15
Q

What is PT management of motor development in SB?

A
  1. Low trunk muscle tone
  2. Prolonged instability of the head and upper body
  3. Delayed or weak acquisition of balance and equilibrium responses
    - Which activities will likely be most difficult?
    - What substitutions may you see?
    - Infant Devices?
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16
Q 
What are the following sx characteristic of:
- Rapidly progressive scoliosis
- Hypertonus at one or several sites in the LE’s
- Changes in gait pattern
- Changes in urologic function
- Increased tone on pROM
- Asymmetric changes in MMT
- Decrease in strength
c/o discomfort in the back or buttocks
A

Tethered cord

17
Q

What is ambulation prognosis if walking is achieved?

A
  1. onset is delayed by about 2 years, compared with infants with typical development
  2. often involves the use of leg braces
  3. Walking is usually unstable and energy costly.
18
Q

Motor level classification?

Some pelvic control is present in sitting or supine (abs or paraspinals); hip hiking from lumborum may also be present

A

T12

19
Q

Motor level classification?

Weak iliopsoas m function is present (grade 2)

A

L1

20
Q

Motor level classification?

iliopsoas, sartorius, and the hip adductors all grade 3 or better

A

L2

21
Q

Motor level classification?

iliopsoas, sartorius, and the hip adductors all grade 3 or better PLUS the quadriceps are grade 3 or better

A

L3

22
Q

Motor level classification?
iliopsoas, sartorius, and the hip adductors all grade 3 or better; the quadriceps are grade 3 or better; medial hamstrings or the TA is grade 3 or better; weak per onus terminus may also be seen

A

L4

23
Q

Motor level classification?
iliopsoas, sartorius, the hip adductors and quads; medial hamstrings or the TA is grade 3 or better; lateral hamstrings grade 3 or better plus one of the following: glut med grade 2 or better, peronus terminus grade 4 or better, or tib post grade 3 or better

A

L5

24
Q

Motor level classification?
exceeds criteria for L5 plus at least 2 of the following: gastroc/ soleus grade 2 or better, glut med grade 3 or better, or glut max grade 2 or better

A

S1

25
Q

Motor level classification?
meets or exceeds criteria for S!, the gastroc/ soleus must be grade 3 or better, and glut med and max are grade 4 or better

A

S2

26
Q

Motor level classification?
all of the lower limb m grougps are normal strength (may be grade 4 in a couple groups); also includes normal-appearingg infants who are too young to be bowel and bladder trained

A

S2-3

27
Q

What is walking prognosis for L1-3, L4-5, and sacral groups?

A
  • L1-L3 = 56% walked but only 32% remained walkers at 10
  • L4-L5 = 84% walked but only 73% remained walkers at 9
  • Sacral 100% achieve and retain walking
28
Q

What are implications for fitness?

A
  1. Sacral leisons increased risk for obesity - promote physical activity for prevention
  2. Impaired aerobic capacity - Significantly reduced V O2 peak level - aerobic training beneficial
  3. Impaired muscle strength - anaerobic and strength training beneficial
  4. Low peak heart rate - 6 minute walk test reproducible (may need a 20-25% change from baseline)
29
Q

What are contraindications for physical activity for children with SB?

A
  1. recent surgery
  2. progressive back pain
  3. poor fitting orthoses

Pediatrics (19 decks)

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